Senior Care Records.

Facility Evaluation Report

Revival Mental Health, LLC, Fountain Valley03/27/2023Licence 306006262

Capacity6
Date signed03/27/2023 01:59:39 PM
The inspector’s account

On 3/27/2023, applicant/administrator participated in COMP II for the below pending facilities: Revival Mental Health LLC/306006262 and Revival Mental Health LLC /306006319. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained.

During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas:

1. Facility operation: License type, client/resident populations, and program

4. Restrictive/Prohibited Health Conditions

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction